Northside Hospital - The Future of Total Joint Replacement Surgery

The Future of Total Joint Replacement Surgery

Posted on: January 01, 2020

 

By Dr. Jeremy Statton

Physicians and scientists are always trying to find new and better ways to help us live our lives without pain. One of the most significant advances in our lifetime has been the development of hip and knee replacement.  Older age was once characterized by painful, deformed joints; but now as we age, we can expect to maintain a healthy, active lifestyle. 

For years the focus on joint replacement surgery had been centered around the design of the implants. How do we make a good enough hip and knee that a patient can return back to the activities they enjoyed before developing osteoarthritis? Thankfully, many of these issues have been solved. The mechanics of hips and knee are better understood. There are improved techniques for fixation to bone, and the concern of longevity has largely been solved as well.  Now when surgeons perform a hip or knee replacement there is a real expectation that the new joint could last at least twenty to forty years, perhaps even longer. 

More recently, however, a different question is being asked. How do we do a better job restoring each person’s anatomy?

While restoring a patient’s anatomy makes obvious sense, it has only been within the last five years that surgeons have been able to utilize computers and digital technology to accomplish this objective in hip replacement. In the past, surgeons typically would feel the patient’s hip and leg to determine if the changes they were making were “good enough.” 

The anterior hip replacement was developed because it allowed for patients to experience a quicker recovery after surgery. While recovery is important, the procedure’s most important contribution has been the ability for the surgeon to analyze what they are doing during the surgery. Since the surgery is performed with the patient laying on their back, the surgeon can take X-rays during the procedure to actually see the changes they are making.

The ability to see eventually led to the ability to analyze. A technology company called JointPoint recognized the need for a digital solution. JointPoint is a computer program that can analyze X-rays to give the surgeon feedback. Instead of guessing, surgeons are able to measure changes within one millimeter. As a result, surgeons are now equipped to do better than make the new hip good enough. The new goal for every hip replacement should be to restore the anatomy perfectly.

Knee replacement surgery is currently undergoing a similar transition that hip replacement underwent with the anterior approach. Traditionally surgeons would use what is known as Mechanical Alignment to make the cuts for a knee. The goal is in this technique is to give every single patient the same knee and then change the soft tissues so that the knee would be balanced. While mechanical alignment is good enough in many patients, it does not work for all. Newer studies are showing us only about one third of all people normally fit into the parameters of mechanical alignment.

Recognizing the need for better restoration of anatomy, some surgeons are starting to utilize a technique called Patient Specific Alignment or Kinematic Alignment. The goal with this technique is to recreate the alignment of the knee before the patient developed osteoarthritis. In other words, to customize the placement of the knee to restore the patient’s normal anatomy. The idea is that if anatomy is restored, then the knee replacement will feel more normal. As the new alignment technique gains favor, more and more surgeons will switch. Eventually a digital solution will be developed for patient specific alignment as well. 

In hip and knee replacement, implant development over the last thirty was useful for making the procedure good enough. The future of hip and knee replacement over the next ten years, though, will be the development of digital solutions that will enable the surgeon to make the new joint anatomically perfect.

Dr. Jeremy Statton is a board-certified orthopedic surgeon at Northside Hospital and Arthritis & Total Joint Specialists in Midtown Atlanta and Sandy Springs. He specializes in minimally-invasive hip and knee replacement for patients suffering from chronic joint pain and arthritis.

Filed under: Physicians,

 

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